5160:1-3-03.2
Medicaid: income exclusions.

(A)
When determining
eligibility for medical assistance for the aged, blind, or disabled, certain
types of income, including income from certain sources, are not counted. This
rule sets forth the types of income that are to be excluded, and the order in
which they must be excluded from the individual's income.

(B)
Definitions.

(1)
"Blind work expense" means the portion of the
individual's earned income used to meet any expenses reasonably attributable to
the earning of the income if the individual is blind and;

(a)
Is under age
sixty-five; or

(b)
Is age sixty-five or older and received SSI payments
due to blindness for the month before attaining age sixty-five.

(2)
"Countable income" means the total earned and unearned
income minus the income exclusions set forth in this rule. It is compared to
the appropriate income standard in determining eligibility for medical
assistance.

(3)
"Exclusion" means an amount of income which does not
count in determining eligibility for medical assistance.

(C)
Order
of exclusions. Unearned income exclusions must be applied before applying
earned income exclusions, and the specific order of exclusions described in
paragraphs (D) and (E) of this rule must be followed.

(D)
Unearned income
exclusions.

(1)
Unearned income excluded by federal laws other than the
Social Security Act, in accordance with 20 C.F.R 416 Subpart K Appendix (as in
effect on February 1, 2016) unless otherwise noted. The exclusions listed in
this paragraph must be applied before applying the exclusions in paragraph
(D)(2) of this rule:

(a)
Agent orange settlement payments;

(b)
Child care
assistance under the Child Care and Development Block Grant Act of 1990 (as in
effect on February 1, 2016);

(c)
The first two
thousand dollars per calendar year received as compensation for participation
in clinical trials that meet the criteria detailed in section 1612(b) of the
Social Security Act (as in effect February 1, 2016);

(d)
Payments made for
supporting services or reimbursement of out-of-pocket expenses to volunteers
participating in corporation for national and community service (CNCS, formerly
ACTION) programs:

(i)
AmeriCorps program;

(ii)
Special and
demonstration volunteer program;

(iii)
University year
for ACTION (UYA);

(iv)
Retired senior volunteer program
(RSVP);

(v)
Foster grandparents program;

(vi)
Senior companion
program;

(e)
Energy employees occupational illness program
payments;

(f)
Federal food and nutrition programs:

(i)
Food assistance
(formerly known as food stamps);

(ii)
U.S. department
of agriculture food commodities distributed by a program (private or
governmental);

(iii)
School breakfast, lunch, and milk
programs;

(iv)
Women, infants, and children program
(WIC);

(v)
Nutrition programs for older Americans;

(g)
Student financial assistance received under the Higher
Education Act of 1965 (as in effect on February 1, 2016) or bureau of Indian
affairs is excluded from income and resources, regardless of use:

(h)
Home energy assistance provided on the basis of need,
in accordance with
20 C.F.R. 416.1157 (as in effect on February 1,
2016);

(i)
Matching funds that are deposited into individual
development accounts (IDAs), either demonstration project or TANF-funded, in
accordance with
42 U.S.C. 604 (as in effect on February 1,
2016);

(j)
Japanese-American and Aleutian restitution
payments;

(k)
Payments to victims of Nazi
persecution;

(l)
Netherlands WUV payments to victims of persecution from
1940-1945;

(m)
Department of defense payments to certain persons
captured and interned in North Vietnam, in accordance with the Departments of
Labor, Health and Human Services, and Education, and Related Agencies
Appropriations Act of 1998 (as in effect on February 1, 2016);

(i)
Certain
Vietnam veterans' natural children regardless of or age or marital status, for
any disability resulting from spina bifida suffered by such
children;

(ii)
Certain Korea service veterans' natural children
regardless of their age or marital status, for any disability resulting from
spina bifida suffered by such children;

(iii)
Women Vietnam
veterans natural children regardless of their age or marital status, for
certain birth defects;

(p)
Austrian social
insurance payments received under the provisions of the Austrian General Social
Insurance Act, paragraphs 500 through 506 (as in effect on February 1, 2016).
These payments must be documented and identifiable from countable
insurance;

(q)
Payments made to Native Americans as listed in section
IV of 20 C.F.R 416 Subpart K Appendix (as in effect on February 1,
2016);

(r)
Payments from the Ricky Ray hemophilia relief fund or
the class settlement in the case of Susan Walker v. Bayer Corporation, et al.
under the Ricky Ray Hemophilia Relief Fund Act of 1988 (as in effect on
February 1, 2016);

(2)
Unearned income
excluded by the Social Security Act, in accordance with
20 C.F.R. 416.1124 (as in effect on February 1, 2016)
unless otherwise noted. The exclusions listed in this paragraph must be applied
after the exclusions listed in paragraph (D)(1) of this rule, and in the
following order:

(a)
Any public agency's refund of taxes on real property or
food;

(b)
Assistance based on need which is provided under a
program which uses income as a factor of eligibility and is wholly funded by a
state or political subdivision. Disability financial assistance (DFA) and
residential state supplement (RSS) payments are included in this
category.

(c)
Grants, scholarships, fellowships, or gifts used for
paying educational expenses are either excluded or countable, depending upon
their use:

(i)
Any portion of a grant, scholarship, fellowship, or gift
used for paying tuition, fees, or other necessary educational expenses at any
educational institution, including vocational or technical education, is
excluded from income.

(ii)
Any portion of such educational assistance that is not
used to pay current tuition, fees or other necessary educational expenses but
is set aside to be used for paying this type of educational expense at a future
date is excluded from income in the month of receipt. If these funds are not
spent after nine months, they become a countable resource as of the tenth month
following receipt.

(iii)
Any portion of a grant, scholarship, fellowship, or
gift that is not used or set aside for paying tuition, fees, or other necessary
educational expenses is income in the month received and a resource the month
after the month of receipt, if retained.

(d)
Food which an
individual or his/her spouse raises if it is consumed by the
household;

(e)
Assistance received under the Disaster Relief and
Energy Assistance Act (as in effect on February 1, 2016) and assistance
provided under any federal statute because of a presidentially-declared
disaster;

(f)
The first sixty dollars of infrequent or irregular
unearned income received in a calendar quarter;

(g)
Alaska longevity
bonus payments;

(h)
Foster care payments;

(i)
Any interest
earned on excluded burial funds and any appreciation in the value of an
excluded burial arrangement which are left to accumulate and become a part of
that burial fund;

(j)
Support and maintenance assistance based on need:

(i)
Provided in kind
by a private nonprofit agency; or

(ii)
Provided in cash
or in kind by a supplier of home heating oil or gas, or by a private or
municipal utility company.

(k)
One-third of
child support payments made by an absent parent;

(l)
Twenty dollar
general income exclusion, but does not apply to income based on need that uses
income as a factor of eligibility and is wholly or partially funded by the
federal government or by a nongovernmental agency. Catholic charities and the
salvation army are nongovernmental agencies;

(m)
Unearned income
used to fulfill an approved plan to achieve self-support
(PASS);

(n)
Federal housing assistance provided by:

(i)
The office of
housing and urban development (HUD); or

(ii)
The U.S.
department of agriculture's rural housing service (RHS), formally known as the
farmers home administration (FHA);

(o)
Any interest on
excluded burial space purchase agreement if left to accumulate as part of the
value of the agreement;

(p)
The value of any commercial transportation ticket which
is received as a gift and is not converted to cash;

(q)
Payments from a
state compensation fund for victims of crime;

(r)
Relocation
assistance provided under title II of the Uniform Relocation Assistance and
Real Property Acquisitions Policies Act of 1970 in accordance with
42 U.S.C. 301 (as in effect on February 1, 2016)
provided to individuals displaced by any federal or federally-assisted project
or state or local government or through a state-assisted or locally-assisted
project in the acquisition of real property;

(s)
Combat fire pay
received from the uniformed services;

(t)
Interest on a
dedicated account in a financial institution, the sole purpose of which is to
receive and maintain past-due supplemental security income (SSI) benefits which
are required or allowed to be paid into such an account, and the use of which
is restricted by section 1631(a)(2)(F) of the Social Security Act (as in effect
on February 1, 2016);

(u)
Gifts to children with life-threatening conditions from
an organization described in section 501(c)(3) of the Internal Revenue Code of
1986 (as in effect on February 1, 2016), within the following
limitations:

(i)
In-kind gifts not converted to cash;

(ii)
The first two
thousand dollars of any cash gifts within a calendar year;

(v)
Interest and dividend income from a countable resource or
from a resource excluded under a federal statute other than section 1613(a) of
the Social Security Act (as in effect on February 1, 2016);

(w)
A state annuity
paid by a state, to an individual and/or the individual's spouse, on the basis
of the state's determination that the individual is a veteran and is blind,
disabled, or aged.

(E)
Earned income
exclusions excluded by the Social Security Act, in accordance with
20 C.F.R. 416.1112 (as in effect on February 1, 2016)
unless otherwise noted. The exclusions listed in this paragraph must be applied
after the unearned income exclusions, and in the following order:

(1)
Earned income tax
credit payments and child tax credit payments;

(2)
The first thirty
dollars of infrequent or irregular earned income received in a calendar
quarter;

(3)
Student earned income exclusion (SEIE) is applied as
follows:

(a)
Earned income of blind or disabled student children under
the age of twenty-two, up to the SEIE monthly limit, and not more than the SEIE
yearly limit. The SEIE monthly and yearly limits are updated and published
annually in the medicaid eligibility policy letter that lists standards and
limits that are changed by the social security administration's cost of living
allowance (COLA).

(b)
Available to a student attending school to include
college, university or a course of vocational or technical training designed to
prepare students for gainful employment.

(4)
Any portion of
the twenty-dollars monthly general income exclusion which has not been excluded
from unearned income in that same month;

(5)
The first
sixty-five dollars of earned income in a month.

(6)
Earned income of
disabled individuals used to pay impairment-related work expenses (IRWEs), as
described in
20 C.F.R. 404.1576 (as in effect on February 1,
2016);

(7)
One-half of remaining earned income in a
month;

(8)
Blind work expenses, as defined in paragraph (B) of
this rule;

(9)
Earned income used to fulfill an approved plan to
achieve self-support (PASS);

(F)
Unused
exclusions.

(1)
Exclusions never reduce earned or unearned income below
zero.

(2)
Unused portions of a monthly exclusion cannot be
carried over for use in subsequent months.

(3)
Unused earned
income exclusions are never applied to unearned income.

(4)
Other than the
twenty-dollar general income exclusion, no unused unearned income exclusion may
be applied to earned income.

(G)
The twenty-dollar
general and sixty-five-dollar earned income exclusions are applied only once to
an eligible couple, even when both members have income, since the couple's
earned income is combined in determining medicaid eligibility.